AD(H)D in Adults

Assessing AD(H)D in Adults

ADHD (Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder) is a neurodevelopmental disorder featuring a group of behavioural symptoms that include the following:

Inattention

Forgetful and disorganised, poor concept of time, frequently loses important items
Difficulty sustaining attention
Poor listening skills, highly distractible, difficulty filtering background noise
Has more than usual difficulty in concentrating on, sustaining and completing tasks

Impulsivity

Unusually impulsive and unable to stop and think before speaking or acting
Finds it difficult to wait their turn and may interrupt others or blurt out responses
Limited tolerance when encountering difficulties; may become angry or upset quickly
Ends jobs, relationships, commitments abruptly
Prone to addictions and unsafe behaviours, e.g. reckless driving

Hyperactivity (ADHD only)

Displays unusually high levels of physical or verbal activity
Fidgets constantly, is restless
Talks excessively
Poor sleep patterns
Over-scheduling behaviour apparent for periods of time

Symptoms must be present in early childhood. Some of these may not become fully manifest until or unless demands increase and supportive structure is reduced

Assessment for ADHD should

Check for symptoms
Assess the level of functional impairment experienced

1 Check for symptoms

The symptom screener used is based on the Adult ADHD Self-Report Scale (ASRS-v1.1) checklist, is an instrument consisting of the eighteen DSM-IV-TR criteria. Ask the patient to complete the Symptom-Screener by marking an X in the box that most closely represents the frequency of occurrence of each of the symptoms.

If four or more marks appear in the darkly shaded boxes within Part A then the patient has symptoms highly consistent with ADHD in adults and further investigation is warranted.

2 Assess Level of Functional Impairment

Review the symptom screener with your patient and evaluate the level of impairment associated with their symptoms.

Consider work, education, social and family settings. The WEISS functional impairment rating scale self-report (WFIRS-S) may be used to assess impact on functioning in more depth.

If a patient describes impact on functioning in two or more areas consider a referral to your locality mental health team.

Who to refer:

A referral to the patient’s local adult mental health sector team (CMHT) for further assessment and treatment should be considered where:

The patient shows no improvement following initial interventions and / or
The patient scores four or more on the ADHD symptom screener and / or
The patient is experiencing significant functional impairment in two or more areas (e.g. family life, work, education, looking after self, social life, risk taking)

Referrals should be made using the adult mental health SCI referral protocol

Please include the initial symptom screener score with the referral.

Who not to refer:

Patients with or without a formal diagnosis who have mild impairment should not be referred for specialist assessment & treatment in the first instance. For these patients the following interventions are recommended – See Primary Care Management and Resources Tabs

Shared Care for ADHD prescribing

The following guidelines for medication treatment of ADHD in adults are found in the Lothian Joint Formulary in the Shared Care Agreements section.

Patient Information

The following resources and web links provide information and signposting on a range of topics that may be useful for those with ADHD and also for some people with no diagnosis of ADHD who experience ongoing difficulties with aspects of their daily functioning impacting on their memory, attention and concentration, organisation and activity levels.

NHS Lothian Adults with ADHD Self Help Resource Pack (June 2017)
Royal College of Psychiatry Leaflet https://www.rcpsych.ac.uk/mental-health/problems-disorders/adhd-in-adults
A general leaflet for adults which includes information about diagnosis, symptoms and what might help.

Local support available:

We are updating a further list of Information, advice and self help materials

Web Links:

www.scottishadhdcoalition.orgScottish charitable coalition representing voluntary organisations supporting adults and children with ADHD and their families
Royal College of Psychiatry Leaflet – A general leaflet for adults which includes information about diagnosis, symptoms and what might help.
www.addiss.co.uk – A U.K. website providing an information and support service. Has a book shop and E-newsletter –ADHD News. Provides information on conferences, training and support groups.
www.ukaan.org – Aimed at clinicians, providing events and training for health care professions. Research, publications and library available here, in order to support the implementation of the NICE guidelines